Provider Demographics
NPI:1366799058
Name:SHEL SHARPE MD, INC
Entity type:Organization
Organization Name:SHEL SHARPE MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-383-3311
Mailing Address - Street 1:39 SHOALS FERRY RD SE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-9199
Mailing Address - Country:US
Mailing Address - Phone:770-383-3311
Mailing Address - Fax:
Practice Address - Street 1:39 SHOALS FERRY RD SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-9199
Practice Address - Country:US
Practice Address - Phone:770-383-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020151261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1508956558OtherNPI
GA1366799058OtherNPI
GAA51984Medicare UPIN